Healthcare Provider Details

I. General information

NPI: 1548339310
Provider Name (Legal Business Name): GREG A. NESTEBY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4433 34TH ST
LUBBOCK TX
79410-2416
US

IV. Provider business mailing address

4433 34TH ST
LUBBOCK TX
79410-2416
US

V. Phone/Fax

Practice location:
  • Phone: 806-792-6193
  • Fax: 806-792-2863
Mailing address:
  • Phone: 806-792-6193
  • Fax: 806-792-2863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number222Z00000X ORTHO 377
License Number StateTX

VIII. Authorized Official

Name: GREGORY ALFRED NESTEBY
Title or Position: OWNER
Credential: L.O., B.O.C., A.B.C.
Phone: 806-792-6193